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INTRODUCTION: Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. MATERIALS AND METHODS: This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. RESULTS: Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at fi ve years and about 15% of adolescents at 15 years of age. Enuresis was classifi ed as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identifi ed in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a signifi cant impact on the quality of life of 67% of the individuals. CONCLUSION: Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.

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ABSTRACT Introduction Evidence indicates an increase in the prevalence of enuresis in individuals with sickle cell disease. The present study aims to evaluate the prevalence and impact of enuresis on quality of life in individuals with sickle cell disease. Materials and Methods This cross-sectional study evaluated individuals with sickle cell disease followed at a reference clinic, using a questionnaire designed to evaluate the age of complete toilet training, the presence of enuresis and lower urinary tract, and the impact on quality of life of these individuals. Results Fifty children presenting SCD (52% females, mean age ten years) were included in the study. Of those, 34% (17/50) presented as HbSC, 56% with HbSS (28/50), 2% Sα-thalassemia (1/5) and 8% the type of SCD was not determined. The prevalence of enuresis was 42% (21/50), affecting 75% of subjects at five years and about 15% of adolescents at 15 years of age. Enuresis was classified as monosymptomatic in 33.3% (7/21) and nonmonosymptomatic in 66.6% (14/21) of the cases, being primary in all subjects. Nocturia was identified in 24% (12/50), urgency in 20% (10/50) and daytime incontinence 10% (5/50) of the individuals. Enuresis had a significant impact on the quality of life of 67% of the individuals. Conclusion Enuresis was highly prevalent among children with SCD, and continues to be prevalent throughout early adulthood, being more common in males. Primary nonmonosymptomatic enuresis was the most common type, and 2/3 of the study population had a low quality of life.

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INTRODUCTION: Although the relationship between enuresis and breastfeeding is still poorly documented in the literature, a possible association is speculated as both are strongly associated with children's development. Therefore, the main objective of this study was to evaluate whether there is an association between primary enuresis and the duration of exclusive breastfeeding. MATERIAL AND METHODS: This is an observational, case-control study, involving 200 children and adolescents from 6 to 14 years old, who were divided into two groups: the enuresis group (EG), composed of 100 children with primary enuresis; and the control group (CG) of 100 matched children without enuresis. The matching criteria were sex, age, and socioeconomic level. Adults responsible for each infant answered a structured questionnaire to identify biological and behavioral factor, as well as the duration of maternal breastfeeding. Children whose parents could not comprehend the questionnaire or children with neurological or psychiatric disorders or secondary enuresis were not included in the study. RESULTS AND DISCUSSION: Evaluating the duration of exclusive breastfeeding, 72% of the subjects of the EG and 42% of the CG had been breastfed for less than 4 months (p < 0.001) (Figure). In bivariate analysis, there was a strong association between symptoms of enuresis with a positive family history of enuresis and duration of exclusive breastfeeding (p < 0.001), and also association with full breastfeeding duration (p = 0.044), number of children (p = 0.045), and parents' education (p = 0.045). After logistic regression, primary enuresis continued to be associated with duration of exclusive breastfeeding and family history of enuresis. The proportion of children that had been exclusively breastfed for more than 4 months was significantly higher in the CG 58% (58/100) than in the EG 28% (28/100) (p < 0.001, OR 4.35, 95% CI 1.99-9.50). CONCLUSIONS: This study confirmed the association between primary enuresis and various factors that have already been studied, with the addition of a new factor, duration of exclusive breastfeeding for less than 4 months, which is strongly associated with primary enuresis.

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UNLABELLED: The study of factors potentially associated with sleep bruxism (SB) may contribute to a better understanding of its nature and etiology. OBJECTIVES: In this way, this cross-sectional study aimed to evaluate the association between SB and salivary cortisol levels, heart rate, and other parafunctional habits. DESIGN AND METHODS: Data were collected in 100 healthy caries-free children of both genders, aged 7.23 ± 0.60 years, with (n=27) and without (n=73) signs and symptoms of SB by interview with the parents and clinical and physical examination. Salivary cortisol was measured immediately after waking up and 30min after awakening for the determination of the area under the response curve (AURC). Data were analyzed by descriptive statistics, normality test, and Spearman correlation test; a stepwise logistic regression model was used to verify the association between SB, as the dependent variable, and age, gender, body mass index (BMI), heart rate, presence of sucking habit, nail biting, enuresis, and AURC (α=0.05). RESULTS: AURC did not correlate with BMI and heart rate. Only AURC showed a significant negative association with SB, while age, gender, BMI, heart rate and other parafunctional habits did not associate with SB. CONCLUSION: In the studied sample, children with SB were more likely to present low concentrations of awakening salivary cortisol.

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OBJECTIVES: To estimate the predictive value of diurnal voiding symptoms for the diagnosis of bladder dysfunction in enuretic children and teenagers receiving care at Fernandes Figueira Institute (Rio de Janeiro, Brazil). METHODS: From June 1999 to May 2002, 91 patients (aged 5-17 years) with enuresis, both monosymptomatic and polysymptomatic, were assessed based on medical history, voiding chart, physical examination, and urodynamic studies. The medical history was investigated for detection of diurnal voiding symptoms. The predictive value of these symptoms for the diagnosis of bladder dysfunction was estimated. RESULTS: Bladder dysfunction was observed in 94.5% of the children and teenagers with enuresis. Medical history identified 97.3% of patients with diurnal voiding symptoms. Increased discharge of urine was detected exclusively by voiding chart in only 2.7% of the patients. The positive predictive value of diurnal voiding symptoms for bladder dysfunction was 98.6%. There was a statistically significant association between diurnal voiding symptoms and bladder dysfunction (p < 0.005). The risk for bladder dysfunction was approximately 20 times higher in presence of these symptoms. CONCLUSIONS: The presence of diurnal voiding symptoms was a strong predictor of bladder dysfunction. Medical history was a useful instrument for detecting diurnal voiding symptoms and establishing the diagnosis of bladder dysfunction.

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OBJETIVO: Estimar o valor preditivo da presença de sintomas urinários diurnos para o diagnóstico de disfunção miccional em crianças e adolescentes enuréticos atendidos no Ambulatório de Urodinâmica do Instituto Fernandes Figueira. MÉTODOS: De junho de 1999 a maio de 2002, foram avaliados 91 pacientes, entre 5 e 17 anos de idade, portadores de enurese, mono ou polissintomática, através de anamnese, mapa da micção, exame físico e estudo urodinâmico. A anamnese baseou-se em um modelo desenvolvido para detecção de sintomas urinários diurnos. O valor preditivo da presença destes sintomas para o diagnóstico de disfunção miccional foi estimado neste grupo. RESULTADOS: O percentual de disfunção miccional entre as crianças e adolescentes atendidos por enurese no Ambulatório de Urodinâmica do Instituto Fernandes Figueira foi de 94,5 por cento. A anamnese identificou 97,3 por cento dos pacientes com sintomas urinários diurnos. Apenas 2,7 por cento dos pacientes apresentaram aumento da freqüência urinária detectado apenas pelo mapa da micção. O valor preditivo positivo da presença de sintomas urinários diurnos para o diagnóstico de disfunção miccional foi de 98,6 por cento. Houve associação, estatisticamente significante, entre sintomas urinários diurnos e disfunção miccional (p < 0,005), e o risco de a urodinâmica estar alterada foi de cerca de 20 vezes maior na presença destes. CONCLUSÕES: A presença de sintomas urinários diurnos apresentou um elevado valor preditivo positivo para disfunção miccional. A anamnese foi um instrumento útil para a detecção dos sintomas urinários diurnos, contribuindo para o diagnóstico de disfunção miccional.

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OBJECTIVE: To assess the clinical significance of after-contractions (A-Cs) in children with normal urinary tracts. PATIENTS AND METHODS: Urodynamic records obtained in 315 children with urinary infection or enuresis were reviewed retrospectively; 184 were selected for analysis of A-Cs. All patients had normal urinary tracts and none showed signs of an overt neuropathy. The urodynamic method comprised standard measurements of pressures and flowmetry (42 had video-urodynamic studies). RESULTS: After-contractions occurred in 151 of the 184 patients; the incidence tended to decrease with age. The mean amplitude of the A-Cs was 77.9 cmH2O; in 36% of the records it was higher than the voiding contraction. Residual urine was found in 12 of 151 records with A-Cs, but in only one patient was such residual urine confirmed in control voids. The patterns were assessed in 131 patients: in 36% they resembled stop-test responses, in 31% they were preceded by brief peaks of pressure or had jagged limbs, and in 33% they were grossly irregular. In 137 records the content of the bladder was estimated at the start of A-Cs; in 51% the bladder was empty or had evacuated >95% of its content, in 39% 95-80% and in 10% <80%. In only 7% of the patients had the A-Cs started after the voiding contraction had completely subsided. There was no difference in the incidence of A-Cs in girls with enuresis (84%) and girls with a history of urinary infections (85%). Detrusor instability was detected in 81% of the children with A-Cs and in 70% of those without; there was no correlation between the amplitudes of uninhibited detrusor contractions and of A-Cs. Characteristic images of external sphincter activity were found in only three of 14 video-urodynamic recordings with A-Cs. CONCLUSION: After-contractions are common in children with normal urinary tracts but they tend to disappear with age. In clinical urodynamics they are of limited practical use because their appearance is unpredictable and there are artefacts related to recording the final phase of micturition. The relationship with detrusor instability may be explained as a coincidence of two common but unrelated findings, and A-Cs are unrelated to urinary infection. External sphincter activity is not the only cause of A-Cs and when it occurs it does not alter the course of voiding, as it does in neuropathic dysfunctions. As their clinical significance is uncertain, treatment of A-Cs is not advocated.

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A enurese é condição de ocorrência frequente, sendo responsável por grande apreensão dos pais, quanto ao desenvolvimento psicológico da criança. Apresenta no entanto, expressiva variação clínica, tendo envolvido em sua gênese fatores cerebrais, vesicais e neurológicos, que interagem entre si favorecendo as perdas urinárias noturnas, ou seu adequado controle social. Dentro do conhecimento atual, distúrbios perenes do sono, podem comprometer o controle adequado da bexiga favorecendo a micção noturna, sem que haja o despertar

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